Abstract General Information

Title

Evaluation of therapeutic failure risk factors in a patient with neuromyelitis optica AQPIV who is treated by Azathioprine

Abstract

Introduction: Neuromyelitis optica (NMO) is an immune-mediated inflammatory neurological and in our country, maintenance therapy options are scarce, therefore research about success rates or therapeutic failure is necessary to implement more effective and wider therapeutic protocols. Objective: Evaluating the demographic data and clinical progression of patients with AQPIV+ NMO who have been treated with azathioprine.
Methodology: Reviewing the medical records of 43 patients with NMO AQPIV who used azathioprine (AZT), whereas 13 showing treatment failure (therapeutic failure group - FG) and 30 successfully treated (therapeutic success group - SG). Results: The average age at the time of first symptoms was similar between groups (33 years in FG and 35 years in SG). The most common initial symptom was optic neuritis with severe presentation. Area postrema (AP) syndrome occurred in a similar proportion. The trunk syndrome occurred as the first symptom only in GS. While Extensive longitudinal transverse myelitis was most common as the initial symptom in FG. Patients who start treatment after the first-year show more treatment failure. The sample shows 26 patient used AZT as initial therapy and 27.7% developed treatment failure and required conversion to methotrexate (23%) or rituximab (77%). The rate of annual relapses after treatment with AZT was reduced with respect to the rate before treatment, in both groups and 38.4% of patients in the FG experienced one relapse per year after starting AZT. Conclusions: In Brazil, AZT is one of the available therapeutic options of NMO and it is usually the first treatment instituted at the time of diagnosis. However, some clinical characteristics such as severity of initial symptoms and a longer time to start treatment are considered risk factors cause failure of treatment with AZT.